Provider Demographics
NPI:1174586630
Name:KROTINE, KAREN PATRICIA (OD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:PATRICIA
Last Name:KROTINE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6756 RICHMOND HWY
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-6701
Mailing Address - Country:US
Mailing Address - Phone:703-768-1677
Mailing Address - Fax:703-765-6483
Practice Address - Street 1:6756 RICHMOND HWY
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-6701
Practice Address - Country:US
Practice Address - Phone:703-768-1677
Practice Address - Fax:703-765-6483
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000398152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU57208Medicare UPIN